Rupture of the acromioclavicular joint: signs, treatment, surgery, rehabilitation

Everyone has long known that sport is health. However, athletes cannot exclude the risk of shoulder injury, for example: when falling. In this case, a rupture of the acromioclavicular joint may occur.

General joint information

It connects the collarbone and the upper part of the scapula. That is, this joint connects the hand with the skeleton. It is held by ligaments: clavicular-acromial and clavicular-wedge-shaped.

This joint is very mobile, therefore it is especially at risk of injury. The rupture of the acromioclavicular joint usually occurs due to damage that causes the separation of the two elements. Naturally, it is accompanied by quite severe pain, especially since moving a hand becomes extremely uncomfortable.

If the treatment of the disease is not started in time, the collarbone can change its position and move up. The shoulder blade along with the entire shoulder girdle will settle down. Naturally, the functionality of the hands is greatly impaired. Damage requires urgent medical attention and appropriate treatment.

Causes of the appearance of pathology

So, a gap in the acromioclavicular joint can be obtained due to the following reasons:

• Direct fall on the shoulder.
• A strong blow to the scapular region.
• A sharp fall on an outstretched arm.

Those people who engage in contact sports are particularly susceptible to such joint damage. Such damage is observed in young people aged 15-25 years, as well as in elderly patients after 55 years.

In what cases does the risk increase?

The rupture of the acromioclavicular joint often occurs due to the influence of such factors:

1. Classes in some sports disciplines: hockey, football, weightlifting.
2. Injuries resulting from gymnastics, falling from a bicycle, skiing.
3. The elderly, when the bones become more fragile, and the ligaments and muscles are no longer so elastic.

Symptoms of pathology

So, a rupture of the acromioclavicular joint, a photo of the damage can be considered in the article, accompanied by such signs:

• Strong pain or increased sensitivity in the affected area.
• Silent clicks in the joint when moving.
• Swelling of the injured place.

Moreover, the patient has excessive pathological joint mobility.

Pathology classification

So, according to the intensity of the traumatic force, the disease can be divided into the following types:

• I type. In this case, the joint receives minimal damage, which leads only to an extension of the acromioclavicular ligament and joint capsule. That is, the joint remains in a stable position.
• II type. Here, the force of the blow is more pronounced. Although the bundle in this case may not completely break. However, the joint itself loses its stability. There are signs of a partial rupture of the acromioclavicular joint. In an X-ray, the specialist can already see the elevation of the lateral clavicular end above the acromial process. However, this distance is not large.
• III type. There is already a traumatic force has a maximum intensity. That is, the ligament breaks completely, which leads to pathological mobility of the joint.

Some time ago, this classification was supplemented by several more points:

• IV type. When this ligament ruptures, the lateral end of the clavicle is displaced back to the trapezius muscle.
• V type. In addition to the fact that in this case the ligament itself breaks, so does the separation of muscles from attachment sites. That is, the clavicle is almost completely separated from the acromial process.
• Type VI is the most complex type of damage in which conservative treatment is useless.

You can also classify damage according to the time of injury:

1. Fresh (if no more than three days have passed since the fall or impact).
2. Stale (the interval between injury and going to the doctor is from three days to 21 days).
3. Old-fashioned. Such damage is considered if more than three weeks have passed after a traumatic impact on the shoulder.

Diagnosis of the disease

If a person suspects a rupture of the acromioclavicular joint, the treatment should only begin after a thorough examination by a traumatologist, which includes:

1. Fixing the patient’s complaints describing exactly how he got injured.
2. Checking the motor range of the shoulder joint.
3. X-ray examination.
4. Ultrasound and MRI. These studies allow us to determine the condition of damaged muscles and show the general picture of damage.

However, if a person has a suspected rupture of the acromioclavicular joint, radiological signs are the most important. Basically, the type of pathology and its severity is determined by the distance between the acromial process and the lateral clavicular end. These signs can be classified as follows:

• I type. In this case, the distance does not exceed 2 mm.
• II type. Then the joint space expands. Despite the fact that the contact between the two elements presented is preserved, the distance between them is quite large, although it does not exceed ½ of the clavicle diaphysis.
• III type. In the picture you can see a strong shift of the scapula down.

Features of the treatment of pathology

If the patient has an accurate diagnosis of “rupture of the acromioclavicular joint”, treatment without surgery can be carried out only if a specific case was attributed to any of the first three types of injuries.

Conservative therapy involves immobilizing a damaged joint on a scarf. It will take 1-2 weeks to be treated in this way. Naturally, the patient will be prescribed a course of pain medication or other symptomatic therapy. After conservative treatment, the patient is prescribed physiotherapy exercises to develop the joint. As an anesthetic, novocaine injections can be used.

Surgical intervention and subsequent recovery

In some cases, to cure a gap in the acromioclavicular joint, surgery is considered the only way to restore the functionality of the hands. In this case, the option of surgical intervention is determined by the doctor. It can be like this:

1. Transosseous fastening of the joint with the help of knitting needles that are passed through the clavicle and acromial process. However, such an intervention has many disadvantages: the intraarticular disk is damaged, the joint can undergo degenerative changes, the fixators are able to migrate.
2. Temporary fixation of the clavicle using a special screw.
3. Correction and fixing of the clavicle in the desired position using a loop made of absorbable materials. In this case, you can not do a second operation to remove the fastening structures.

If the patient underwent surgery to remove the gap of the acromioclavicular joint, rehabilitation is a mandatory step that will make it possible to restore the normal functionality of the joint. After the intervention, it is necessary to start a course of physiotherapy exercises in a few days. If a second operation is provided to eliminate metal structures, then it is carried out 6-10 weeks after their installation.

Prognosis, possible complications and disease prevention

When conservative therapy of the first three types of injuries is used, recovery is quick enough. After surgery, the rehabilitation period lasts a little longer, but the patient has a very high chance of full recovery. Although the risk of complications reaches 20%. In addition, a heavy load on a cured joint can lead to repeated rupture.

As for the complications, they can be as follows: ossification of the clavicular and wedge-shaped ligaments; degenerative changes in the joint itself; the development of arthrosis, which is accompanied by severe pain; the formation of a keloid scar due to a fracture of the fixative or its migration.

In order not to get the damage presented, it is necessary to observe some precautions:

• It is necessary to try to avoid injuries of the shoulder girdle.
• It is advisable to strengthen the muscles and develop their flexibility through exercise.
• During sports, protective equipment should be used.
• You need to be especially careful if the room has a large number of cords or slippery floors are present.
• You need to walk along well-lit stairs, and it is also better to hold onto the railing.
• Proper and complete nutrition will help strengthen bones and keep joints healthy for a long time.

That's all the features of the treatment of the presented pathology. Naturally, it is better to follow the above preventive measures. Indeed, over time, damaged joints make themselves felt when they begin to respond to changes in weather or atmospheric pressure. Be healthy!